Nutrition: The Vitamins

Identify who might benefit from multivitamin-mineral supplements and identify guidelines for selecting supplements.

People with nutrient deficiencies. Women who are capable of becoming pregnant (supplemental or enrichment sources of folic acid are recommended to reduce risk of neural tube defects in infants). Pregnant or lactating women (they may need iron and folate). Newborns (they are routinely given a vitamin K dose). Infants (they may need various supplements; see Chapter 13). People who undergo weight-loss surgery (this creates nutrient malabsorption). Those who are lactose intolerant (they need calcium to forestall osteoporosis). Habitual dieters (they may eat insufficient food). Elderly people often benefit from some of the vitamins and minerals in a balanced supplement (they may choose poor diets, have trouble chewing, or absorb or metabolize nutrients less efficiently; see Chapter 14). People living with HIV or other wasting illnesses (they lose nutrients faster than foods can supply them). Those addicted to drugs or alcohol (they absorb fewer and excrete more nutrients; nutrients cannot undo damage from drugs or alcohol). Those recovering from surgery, burns, injury, or illness (they need extra nutrients to help regenerate tissues). Strict vegetarians (vegans may need vitamin b12 , vitamin D, iron, and zinc). People taking medications that interfere with the body's use of nutrients. remain aware that sales of vitamin supplements often approach the realm of quackery because the profits are high and the industry is largely free of oversight. To escape the clutches of the health hustlers, use your imagination, and delete the label pictures of sexy, active people and the meaningless, glittering generalities like "Advanced Formula" or "Maximum Power." Also, ignore vague references to the functioning of body systems or common complaints, such as cramps (Chapter 2 illustrated such claims)—most of these are overstatements of the truth. Avoid "extras" such as herbs (see Chapter 11). And don't be misled into buying and taking unneeded supplements, because none are risk-free. Reading the Label Now all you have left is the Supplement Facts panel in Figure C7-1 that lists the nutrients, the ingredients, the form of the supplement, and the price—the plain facts. You have two basic questions to answer. The first question: What form do you want—chewable, liquid, or pills? If you'd rather drink your vitamins and minerals than chew them, fine. If you choose a fortified liquid meal replacer, a sugary vitamin drink, or an "energy bar" (a candy bar to which vitamins and other nutrients are added), you must then proportionately reduce the calories you consume in food to avoid gaining unwanted weight. If you choose chewable pills, be aware that vitamin C can erode tooth enamel. Swallow promptly and flush the teeth with a drink of water.

Identify toxicity problems, if any, for each vitamin.

Vitamin A: Pregnant women, especially, should be wary—excessive vitamin A during pregnancy can injure the spinal cord and other tissues of the developing fetus, causing birth defects. Hair loss, rashes, hemmorrage, bone abnormalities, birth defects, fractures, liver failure, death. beta-carotene: Eating patterns lacking in dark green, leafy vegetables and orange vegetables are associated with the most common form of age-related blindness, macular degeneration.Footnote Footnote The macula, a yellow spot of pigment at the focal center of the retina (identified in Figure 7-1), loses integrity, impairing the most important field of vision, the central focus. Beta-carotene: from food is not converted to retinol efficiently enough to cause vitamin A toxicity. A steady diet of abundant pumpkin, carrots, or carrot juice, however, has been known to turn light-skinned people bright yellow because beta-carotene builds up in the fat just beneath the skin and imparts a harmless yellow cast (see Figure 7-5). Likewise, red-colored carotenoids confer a rosy glow on those who consume the fruits and vegetables that contain them.Footnote Food sources of the carotenoids are safe, but concentrated supplements may have adverse effects of their own. Vitamin D: Vitamin D is the most potentially toxic among the vitamins. Vitamin D intoxication raises the concentration of blood calcium by withdrawing bone calcium, which can then collect in the soft tissues and damage them. With chronic high vitamin D intakes, kidney and heart function decline, blood calcium spins further out of control, and death ensues when the kidneys and heart ultimately fail. Elevated blood calcium; calcification of soft tissues (blood vessels, kidneys, heart, lungs, tissues of joints), excessive thirst, headache, nausea, weakness High doses of vitamin D may bring on high blood calcium, nausea, fatigue, back pain, irregular heartbeat, and increased urination and thirst.Footnote Several reports of patients with high blood calcium have emerged as more and more people self-prescribe high-dose vitamin D supplements in response to preliminary reports of potential health benefits. Vitamin E:Augments the effects of anticlotting medication Vitamin K: Toxicity induces breakage of the red blood cells and release of their pigment, which colors the skin yellow. A toxic dose of synthetic vitamin K causes the liver to release the blood cell pigment (bilirubin) into the blood (instead of excreting it into the bile) and leads to jaundice. Vitamin C: Nausea, abdominal cramps, diarrhea; rashes; interference with medical tests and drug therapies; in susceptible people, aggravation of gout or kidney stones Niacin: Painful flush, hives, and rash ("niacin flush"); excessive sweating; blurred vision; liver damage, impaired glucose tolerance Folate: Masks vitamin -deficiency symptoms B6: Depression, fatigue, impaired memory, irritability, headaches, nerve damage causing numbness and muscle weakness progressing to an inability to walk and convulsions; skin lesions

Vitamin C

Used in connective tissue formation. Really important in wound healing. Also an antioxidant. deficiency: scurvy. bruises, teeth falling out, blood vessels breaking. gum bleeding. corkscrew hair. potatos, citrus fruits, oranges, lemons, limes, broccoli, strawberries, and peppers

Identify major food sources of each vitamin, including factors (if any) that enhance or interfere with the use of a specific vitamin.

Vitamin A: fortified milk, cooked carrots, baked sweet potato, cooked spinach, cooked beef liver and boc choy, apricots. Active vitamin A is present in foods of animal origin. The richest sources are liver and fish oil, but milk and milk products and other vitamin A-fortified foods such as enriched cereals can also be good sources. Even butter and eggs provide some vitamin A. The vitamin A precursor beta-carotene is naturally present in many vegetable and fruit varieties and may be added to cheeses for its yellow color. Beta Carotene: Bright orange fruits and vegetables derive their color from beta-carotene and are so colorful that they decorate the plate. Carrots, sweet potatoes, pumpkins, mango, cantaloupe, and apricots are all rich sources of beta-carotene—and therefore contribute vitamin A to the eyes and to the rest of the body—so, yes, eating carrots does promote good vision. Another colorful group, dark green vegetables, such as spinach, other greens, and broccoli, owes its deep dark green color to the blending of orange beta-carotene with the green leaf pigment chlorophyll. Vitamin D: Vitamin D is unique among nutrients in that, with the help of sunlight, the body can synthesize all it needs. In this sense, vitamin D is not an essential nutrient—given sufficient sun each day, most people can make enough to meet their need from this source. Vitamin D and calcium are inextricably linked in nutrition—no matter how much vitamin D you take in, it cannot make up for a chronic shortfall of calcium. The reverse is also true: excess calcium cannot take the place of sufficient vitamin D for bone health. Found in enriched cereal, sardines, salmon or mackerel, sunlight, cod-liver, fortified milk, and tuna Vitamin E: Vitamin E in foods is safe to consume, and reports of vitamin E toxicity symptoms are rare across a broad range of intakes. However, vitamin E in supplements augments the effects of anticoagulant medication used to oppose unwanted blood clotting, so people taking such drugs risk uncontrollable bleeding if they also take vitamin E. Supplemental doses of vitamin E prolong blood clotting times and increase the risk of brain hemorrhages, a form of stroke that has been noted among people taking supplements of vitamin E. Much of the vitamin E that people consume comes from vegetable oils and products made from them, such as margarine and salad dressings. Wheat germ oil is especially rich in vitamin E. SAFFLOWER OIL* (raw)MAYONNAISE (safflower oil) CANOLA OIL* (raw)SUNFLOWER SEEDS* (dry roasted kernels) Vitamin K: The main function of vitamin KFootnote is to help activate proteins that help clot the blood. Vitamin K is also necessary for the synthesis of key bone proteins. With low blood vitamin K, the bones produce an abnormal protein that cannot effectively bind the minerals that normally form bones.vitamin K can be obtained from a nonfood source—in this case, the intestinal bacteria. Billions of bacteria normally reside in the intestines, and some of them synthesize vitamin K. People who have taken antibiotics that have killed the bacteria in their intestinal tracts also may develop vitamin K deficiency. In other medical conditions, bile production falters, making lipids, including all of the fat-soluble vitamins, unabsorbable. Supplements of the vitamin are needed in these cases because a vitamin K deficiency can be fatal. CABBAGE (steamed) SPINACH (steamed)SOYBEANS (dry roasted) KALE (cooked)ASPARAGUS (cooked)SALAD GREENSAmong protein foods, soybeans, green and black-eyed peas, and split pea soup are rich sources. Canola and soybean oils (unhydrogenated liquid oils) provide smaller but still significant amounts; fortified cereals can also be rich sources of added vitamin K Vitamin C: Connective Tissue The enzymes involved in the formation and maintenance of the protein collagen depend on vitamin C for their activity, as do many other enzymes of the body. Collagen forms the base for all of the connective tissues: bones, teeth, skin, and tendons. Collagen forms the scar tissue that heals wounds, the reinforcing structure that mends fractures, and the supporting material of capillaries that prevents bruises. Vitamin C also participates in other synthetic reactions, such as in the production of carnitine, an important compound for transporting fatty acids within the cells, and in the creation of certain hormones. Antioxidant Activity Vitamin C also acts in a more general way as an antioxidant.Footnote Vitamin C protects substances found in foods and in the body from oxidation by being oxidized itself. For example, cells of the immune system maintain high levels of vitamin C to protect themselves from free radicals that they generate to use during assaults on bacteria and other invaders. After use, some oxidized vitamin C is degraded irretrievably and must be replaced by the diet. Most of the vitamin, however, is not lost but efficiently recycled back to its active form for reuse. In the intestines, vitamin C protects iron from oxidation and so promotes its absorption. Once in the blood, vitamin C protects sensitive blood constituents from oxidation, reduces tissue inflammation, and helps to maintain the body's supply of vitamin E by protecting it and recycling it to its active form. The antioxidant roles of vitamin C are the focus of extensive study, especially in relation to chronic disease prevention. So far, research has yielded only disappointing results: oral vitamin C supplements are useless against heart disease, cancer, and other diseases unless they are prescribed to treat a deficiency. One effect observed with a 2-gram dose is alteration of the insulin response to carbohydrate in people with otherwise normal glucose tolerances. People taking anticlotting medications may unwittingly counteract the drug's effect if they also take massive doses of vitamin C. Those with kidney disease, a tendency toward gout, or abnormal vitamin C metabolism are prone to forming kidney stones if they take large doses of vitamin C.Footnote Vitamin C supplements in any dosage may be unwise for people with an overload of iron in the body because vitamin C increases iron absorption from the intestine and releases iron from storage. Other adverse effects are mild, including digestive upsets, such as nausea, abdominal cramps, excessive gas, and diarrhea. Collagen synthesis (strengthens blood vessel walls, forms scar tissue, provides matrix for bone growth), antioxidant, restores vitamin E to active form, supports immune system, boosts iron absorption SWEET RED PEPPER (chopped, raw) BRUSSELS SPROUTS (cooked)GRAPEFRUIT GREEN PEPPER (chopped, raw)SWEET POTATO ORANGE JUICE GREEN PEPPER (chopped, raw) BROCCOLI (cooked) STRAWBERRIES BOK CHOY (cooked) Thiamin: ENRICHED PASTA PORK CHOP (lean only) GREEN PEAS (cooked) WAFFLE ENRICHED WHEAT BAGEL ENRICHED CEREAL (ready-to-eat) SUNFLOWER SEEDS (raw kernels) BAKED POTATO BLACK BEANS (cooked) Riboflavin: People in this country obtain over a quarter of their riboflavin from enriched breads, cereals, pasta, and other grain products, while milk and milk products supply another 20 percent. Certain vegetables, eggs, and meats contribute most of the rest (see Snapshot 7-7). Ultraviolet light and irradiation destroy riboflavin. For these reasons, milk is sold in cardboard or opaque plastic containers, and precautions are taken if milk is processed by irradiation. Riboflavin is heat stable, so cooking does not destroy it. BEEF LIVER (cooked) COTTAGE CHEESE ENRICHED CEREAL (ready-to-eat) SPINACH (cooked) MILK YOGURT (plain) PORK CHOP (lean only) MUSHROOMS (cooked) Riboflavin is destroyed by ordinary light. Niacin: For over 50 years, large doses of a form of niacin have been prescribed to help improve blood lipids associated with cardiovascular disease.Footnote Footnote Its use is limited, however, by the most common side effect of large doses of niacin, the "niacin flush," a dilation of the capillaries of the skin with perceptible tingling that can be painful.Footnote Today, effective, well-tolerated drugs are often used instead, and scientists question the effectiveness of niacin and debate its utility.Footnote Reported risks from large doses of niacin include liver injury, digestive upset, impaired glucose tolerance, serious infection, muscle weakness, and, rarely, vision disturbances. CHICKEN BREAST PORK CHOP BAKED POTATO TUNA (in water) ENRICHED CEREAL (ready-to-eat) MUSHROOMS (cooked) Folate: BEEF LIVER (cooked) PINTO BEANS (cooked) ASPARAGUS AVOCADO LENTILS (cooked) SPINACH (raw) ENRICHED CEREAL (ready-to-eat) BEETS B12: CHICKEN LIVER SIRLOIN STEAK COTTAGE CHEESE PORK ROAST SARDINES TUNA (in water) SWISS CHEESE ENRICHED CEREAL Vitamin occurs only in animal products. Vitamin -deficiency anemia mimics folate deficiency and arises with low intakes or, more often, poor absorption. Folate supplements can mask a vitamin deficiency. Prolonged vitamin deficiency causes nerve damage. B6: BEEF LIVER (cooked) BANANA SWEET POTATO (cooked) BAKED POTATO CHICKEN BREAST SPINACH (cooked)

Vitamin K

Also called fitoquinal. clots blood. dark leafy greens, or collared greens, cabbage, broccoli, brussel sprouts.

Vitamin E

Also called ticaferol. Antioxidant. Used in blood clotting (with vitamin K) thins the blood. polyunsaturated fatty oils, vegetable oils, nuts, seeds, eggs.

Vitamin A

Has a pro vitamin called beta carotene (antioxidant). Used in gene expression. Cell differentiation (so the cells know which kind of cell to become). Tissue development, esp epethelial, mucus membranes and skin. Development of bone and membranes and parts of the eye. Used in immune function. Used in reproduction and growth, fetal development and sperm production. Bone growth. Vision, used in process of light perception, esp. in dim lighting. Part of a healthy cornia. Deficiency can lead to cornia hardening and blindness. Deficiency: rough, scaly skin. Increased risk for infections, esp eye tissues and gi tract. Measles can be worse. Can lead to night-blindess, or permanent blindness. Toxic: birth defects if pregnant mother has too much. Liver damage. Hypercarotenemia, high beta carotene. Yellow and orange skin. Food sources: deep orange/yellow fruits and vegetables. Pumpkin, sweet potato, carrots, mango, apricots. Dark leafy greens. Liver. Eggs. Fortified milk.

Describe how to minimize nutrient losses during food storage and preparation.

Prevent enzymatic destruction: Refrigerate most fruits, vegetables, and juices to slow breakdown of vitamins. Protect from light and air: Store milk and enriched grain products in opaque containers to protect riboflavin. Store cut fruits and vegetables in the refrigerator in airtight wrappers; reseal opened juice containers before refrigerating. Prevent heat destruction or losses in water: Wash intact fruits and vegetables before cutting or peeling to prevent vitamin losses during washing. Cook fruits and vegetables in a microwave oven, or quickly stir fry, or steam them over a small amount of water to preserve heat-sensitive vitamins and to prevent vitamin loss in cooking water. Recapture dissolved vitamins by using cooking water for soups, stews, or gravies. Avoid high temperatures and long cooking times.

Antioxidants

Vitamin E, C, beta carotene, and mineral selenium

Identify the major functions of each vitamin.

Vitamins A and D act somewhat like hormones, directing cells to convert one substance to another, to store this, or to release that. They also directly influence the genes, thereby regulating protein production. (Three forms of vitamin A are active in the body. One of the active forms, retinol, is stored in specialized cells of the liver. The liver makes retinol available to the bloodstream and thereby to the body's cells. The cells convert retinol to its other two active forms, retinal and retinoic acid, as needed.vFoods derived from animals provide forms of vitamin A that are readily absorbed and put to use by the body. Foods derived from plants provide beta-carotene, which must be converted to active vitamin A before it can be used as such. functions: Vision; maintenance of cornea, epithelial cells, mucous membranes, skin; growth; regulation of gene expression; reproduction; immunity) Vitamin A cont. In plants, vitamin A exists only in its precursor forms. Beta-carotene, the most abundant of these carotenoid precursors, has the highest vitamin A activity. Other carotenoids, although not vitamins, may play other roles in human health.Footnote Beta-carotene is one of many dietary antioxidants present in foods—others include vitamin E, vitamin C, the mineral selenium, and many phytochemicals Vitamin D: must undergo a series of chemical transformations in the liver and kidneys to activate it. Once activated, vitamin D has profound effects on the tissues.best-known member of a large cast of nutrients and hormones that interact to regulate blood calcium and phosphorus levels—and thereby maintain bone integrity. Activated vitamin D functions as a hormone—that is, a compound manufactured by one organ of the body that acts on other organs, tissues, or cells. Inside cells, for example, vitamin D acts at the genetic level to affect how cells grow, multiply, and specialize. Vitamin D exerts its effects all over the body, from hair follicles, to reproductive system cells, to cells of the immune system. When ultraviolet (UV) light rays from the sun reach a cholesterol compound in human skin, the compound is transformed into a vitamin D precursor and is absorbed directly into the blood. Slowly, over the next day and a half, the liver and kidneys finish converting the inactive precursor to the active form of vitamin D. Diseases that affect either the liver or the kidneys can impair this conversion and therefore produce symptoms of vitamin D deficiency. Mineralization of bones and teeth (raises blood calcium and phosphorus by increasing absorption from digestive tract, withdrawing calcium from bones, stimulating retention by kidneys) Vitamin E flows throughout the body, guarding the tissues against harm from destructive oxidative reactions. Vitamin E is an antioxidant and thus acts as a bodyguard against oxidative damage. Such damage occurs when highly unstable molecules known as free radicals, formed during normal cell metabolism, run amok. Left unchecked, free radicals create a destructive chain reaction that can damage the polyunsaturated lipids in cell membranes and lipoproteins, the DNA in genetic material, and the working proteins of cells. This creates inflammation and cell damage associated with aging processes, cancer development, heart disease, and other diseases.Footnote Vitamin E, by being oxidized itself, quenches free radicals and reduces inflammation.The antioxidant protection of vitamin E is crucial, particularly in the lungs, where high oxygen concentrations would otherwise disrupt vulnerable membranes. Red blood cell membranes also need vitamin E's protection as they transport oxygen from the lungs to other tissues. White blood cells that fight diseases equally depend on vitamin E's antioxidant nature, as do blood vessel linings, sensitive brain tissues, and even bones.Footnote Tocopherols also perform some nonantioxidant tasks that support the body's health. Vitamin K is necessary for blood to clot and for bone health. Vitamin C: maintaining the connective tissues and as an antioxidant. B Vitamins: The B vitamins function as part of coenzymes. A coenzyme is a small molecule that combines with an enzyme (described in Chapter 6) and activates it. Sometimes the vitamin part of a coenzyme forms the active site of the enzyme where the chemical reaction takes place. The substance to be worked on is attracted to the active site and snaps into place, enabling the reaction to proceed instantaneously. The shape of each enzyme predestines it to accomplish just one kind of job. Every B vitamin is part of one or more coenzymes that make possible the body's chemical work. For example, the niacin, thiamin, and riboflavin coenzymes are important in the energy pathways. The folate and vitamin coenzymes are necessary for making RNA and DNA and thus new cells. The vitamin coenzyme is necessary for processing amino acids and therefore protein. More specifically, active forms of five of the B vitamins—thiamin, riboflavin, niacin, pantothenic acid, and biotin—participate in the release of energy from carbohydrate, fat, and protein. Vitamin helps the body use amino acids to synthesize proteins; the body then puts the protein to work in many ways—to build new tissues, to make hormones, to fight infections, or to serve as fuel for energy, to name only a few. Folate and vitamin help cells to multiply, which is especially important to cells with short life spans that must replace themselves rapidly. Such cells include both the red blood cells (which live for about 120 days) and the cells that line the digestive tract (which replace themselves every 3 days). These cells absorb and deliver energy to all the others. In short, each and every B vitamin is involved, directly or indirectly, in energy metabolism. Thiamin:Part of coenzyme active in energy metabolism riboflavin: plays a role in the energy metabolism of all cells. Niacin: like thiamin and riboflavin, participates in the energy metabolism of every cell. Its absence causes serious illness. Niacin deficiency causes the disease pellagra, which can be prevented by adequate niacin intake or adequate dietary protein. The amino acid tryptophan can be converted to niacin in the body. folate: Each new cell must be equipped with new genetic material—copies of the parent cell's DNA—and folate helps to synthesize DNA. Folate also participates in the metabolism of vitamin and several amino acids. Part of a coenzyme needed for new cell synthesis B12: Vitamin and folate are closely related: each depends on the other for activation. By itself, vitamin also helps to maintain the sheaths that surround and protect nerve fibers. Part of coenzymes needed in new cell synthesis; helps to maintain nerve cells B6: Vitamin participates in more than 100 reactions in body tissues and is needed to help convert one kind of amino acid, which cells have in abundance, to other nonessential amino acids that the cells lack. In addition, vitamin functions in these ways: Aids in the conversion of tryptophan to niacin. Plays important roles in the synthesis of hemoglobin and neurotransmitters, the communication molecules of the brain. (For example, vitamin assists the conversion of the amino acid tryptophan to the mood-regulating neurotransmitter serotonin.) Assists in releasing stored glucose from glycogen and thus contributes to the regulation of blood glucose. Plays roles in immune function and steroid hormone activity. Is critical to the developing brain and nervous system of a fetus; deficiency during this stage causes behavioral problems later.Part of a coenzyme needed in amino acid and fatty acid metabolism; helps to convert tryptophan to niacin and to serotonin; helps to make hemoglobin for red blood cells

What is a vitamin

essential. complex carbon based chemical structures. perform many functions. don't provide calories.

Free radical

hydrogen or oxygen loses an electron, molucule is reactive, go around and steal electrons from other molucules and making them oxidized because it loses an electron. Happens all the time. They are oxidized, and can damage dna, and cell membranes. Antioxidants donate electrons to free radicals to stabalize them, and repare the oxidized molucule without becoming one.

What is a provitamin?

substance that the body can convert to a vitamin, ex. beta carotene to vitamin A

Identify the key differences between fat-soluble and water-soluble vitamins.

Fat-Soluble Vitamins: Vitamins A, D, E, and K: Absorbed like fats, first into the lymph and then into the blood. Must travel with protein carriers in watery body fluids; stored in the liver or fatty tissues. Not readily excreted; tend to build up in the tissues. Toxicities are likely from supplements but occur rarely from food. Needed in periodic doses (perhaps weeks or even months) because the body can draw on its stores. Water-Soluble Vitamins: B Vitamins and Vitamin C: Absorbed directly into the blood. Travel freely in watery fluids; most are not stored in the body. Readily excreted in the urine. Toxicities are unlikely but possible with high doses from supplements. Needed in frequent doses (perhaps 1 to 3 days) because the body does not store most of them to any extent. Water-soluble vitamins are easily absorbed and excreted from the body, and foods that supply them must be consumed frequently. Water-soluble vitamins are easily lost or destroyed during food preparation and processing.

Vitamin D

Helps bones, helps to maintain calcium. Needed for gi track. Decreases calcium loss in kidney, and absorb calcium in gi track. Can take calcium from bones if blood calicum is low. Can incorporate calcium into bones. Rickets (children, bow legs) and soft bones(adults). Toxicity: excess calcium deposited in soft tissues, joints, heart, lungs, kidneys. Abnormal bone growth. Fatty fish and fish liver oil, beef liver, egg yolks. Fortified milk. Your body can create vitamin D from the sun.

B Vitamins

Used as co-enzyme. Usually enzymes needed for motabolysm. Deficiency: tired, weak. Beriberi (thiamin deficiency, found in east asia bc of unfortified rice, stiff neck, nerve problems, poor coordination, edima which means you puff off because of fluid) Riboflavan def. gives you cracks by edge of your mouth. Good source is milk. Light can destroy roboflavan. Pellagra comes from def of niacin. demencia, diarrhea, dry flaky skin (dermetitis), death. Too much niacin, low blood pressure, blood flushing in skin. thiamin: enriched or foritified grains riboflavin: milk, fortified and enriched grains niacin: meats (triptofan can be converted to niacin) folate: helps with dna synthesis, cell synthesis and division. Neural tube defect when pregnant women have a deficiency. (bottom of spine doesn't close) spine endifida. happens in very beginning of pregnancy, women who could become pregant shouldn't have a dificiency. divides red blood cells. if deficiency, macrocytic anemia. bigger red blood cells that are unable to divide. follage. leafy greens and fortified grains. Vitamin B12: you need adequate stomach acid to absorb. You also need intrinsic factor, made in stomach, to absorb b12 from stomach into blood stream. If you don't have if you can get pernicious anemia. (related to blood cells, fewer red blood cells, pale, abnormal. treatment is getting b12 injections) meat, fish, or poultry (animal products, enriched milk products by b12 for vegetarians) Vitamin B6: used everywhere. deficiency: weak, irritable, confused. toxicity: simmilar to other b vitamins, nerve damage (tingling in hands and feet) meat, fish and poultry.

Identify the disease name, if any, and symptoms of each vitamin deficiency disease.

Vitamin A: Night blindness, not being able to see in the dark for a while after flashes of light. Can lead to Xerophthalmia and Blindness. If vitamin A is deficient, cell differentiation is impaired, and goblet cells fail to mature, fail to make protective mucus, and eventually die off. Goblet cells are then displaced by cells that secrete keratin, mentioned earlier with regard to the eye. Keratin is the same protein that provides toughness in hair and fingernails, but in the wrong place, such as skin and body linings, keratin makes the tissue surfaces dry, hard, and cracked. As dead cells accumulate on the surface, the tissue becomes vulnerable to infection (see Figure 7-3). In the cornea, keratinization leads to xerophthalmia; in the lungs, the displacement of mucus-producing cells makes respiratory infections likely; in the urinary tract, the same process leads to urinary tract infections. When the defenses are weak, especially in vitamin A-deficient children, an illness such as measles can become severe. Failure to grow is one of the first signs of poor vitamin A status in a child. Symptoms = hard lumps on skin. not only night blindness but diarrhea, appetite loss, and reduced food intake that can rapidly worsen their condition. Decreased immunity. Vitamin D: deficit of vitamin D may be to invite problems of many kinds, including cardiovascular diseases and risk factors, some cancers, respiratory infections such as tuberculosis or flu, inflammatory conditions, multiple sclerosis, and a higher risk of death. The most obvious sign occurs in early life—the abnormality of the bones in the disease rickets is shown in Figure 7-6. Children with rickets develop bowed legs because they are unable to mineralize newly forming bone material, a rubbery protein matrix. As gravity pulls their body weight against these weak bones, the legs bow. Many such children also have a protruding belly because of lax abdominal muscles. bowed legs, knock-knees, beaded ribs, and protruding (pigeon) chests of rickets. In adults, poor mineralization of bone results in the painful bone disease osteomalacia.Footnote The bones become increasingly soft, flexible, weak, and deformed. Older people can suffer painful joints if their vitamin D levels are low, a condition easily misdiagnosed as arthritis during examinations. Inadequate vitamin D also sets the stage for a loss of calcium from the bones, which can result in fractures from osteoporosis. Some medications can also compromise vitamin D status. obesity may cause a decrease in vitamin D status and, therefore, weight loss may help to correct the apparent deficiency. First, extra fat tissue requires a great deal of extra blood flow, so vitamin D, even if amply consumed, may become diluted in the overweight person's larger blood volume, producing below-normal test results. Second, fat-soluble vitamin D may be taken up and sequestered in the fat tissue of the overweight person, making it less available to the bloodstream, thus lowering test results.Footnote In the end, a combination of low intakes, greater blood volume, and sequestering may be responsible for low vitamin D values in many overweight people. Vitamin D deficiency is likely in overweight people, those in northern climates, those who lack sun exposure, and among adults, breastfed infants, and adolescents with darker skin. malformed teeth; muscle spasms Vitamin E: Disease or injury of the liver (which makes bile, necessary for digestion of fat), the gallbladder (which delivers bile into the intestine), or the pancreas (which makes fat-digesting enzymes) makes vitamin E deficiency likely. In people without diseases, low blood levels of vitamin E are most likely when diets extremely low in fat are consumed for years.A classic vitamin E deficiency occurs in premature babies born before the transfer of the vitamin from the mother to the fetus, which takes place late in pregnancy. Without sufficient vitamin E, the infant's red blood cells rupture (erythrocyte hemolysis), and the infant becomes anemic. The few symptoms of vitamin E deficiency observed in adults include loss of muscle coordination and reflexes and impaired vision and speech. Vitamin E corrects all of these symptoms. Red blood cell breakage, nerve damage Vitamin K: Newborn infants present a unique case with regard to vitamin K because they are born with a sterile intestinal tract and the vitamin K-producing bacteria take weeks to establish themselves. To prevent hemorrhage, the newborn is given a single dose of vitamin K at birth. Vitamin C: Most of the symptoms of scurvy can be attributed to the breakdown of collagen in the absence of vitamin C: loss of appetite, growth cessation, tenderness to touch, weakness, bleeding gums (shown in Figure 7-9), loose teeth, swollen ankles and wrists, and tiny red spots in the skin where blood has leaked out of capillaries (also shown in the figure). One symptom, anemia, reflects an important role worth repeating—vitamin C helps the body to absorb and use iron. Vitamin C is listed among the nutrients of national concern because U.S. intakes may fall short of the DRI recommendations. Especially people who smoke or have low incomes are at risk for deficiency. The disease scurvy is seldom seen today except in a few elderly people, people addicted to alcohol or other drugs, sick people in hospitals, and a few infants who are fed only cow's milk.Footnote Breast milk and infant formula supply enough vitamin C, but infants who are fed cow's milk and receive no vitamin C in formula, fruit juice, or other outside sources are at risk. As for the elderly, poor appetites and low intakes of fruits and vegetables often lead to low vitamin C intakes. Scurvy, with pinpoint hemorrhages, fatigue, bleeding gums, bruises; bone fragility, joint pain; poor wound healing, frequent infections B Vitamins: in a B vitamin deficiency, every cell is affected. Among the symptoms of B vitamin deficiencies are nausea, severe exhaustion, irritability, depression, forgetfulness, loss of appetite and weight, pain in muscles, impairment of the immune response, loss of control of the limbs, abnormal heart action, severe skin problems, swollen red tongue, cracked skin at the corners of the mouth, and teary or bloodshot eyes. Figure 7-13 shows two of these signs. Because cell renewal depends on energy and protein, which, in turn, depend on the B vitamins, the digestive tract and the blood are invariably damaged. In children, full recovery may be impossible. In the case of a thiamin deficiency during growth, permanent brain damage can result. Thiamin: Beriberi, In developed countries today, alcohol abuse often leads to a severe form of thiamin deficiency, Wernicke-Korsakoff syndrome, defined in Controversy 3. Alcohol contributes energy but carries almost no nutrients with it and often displaces food from the diet. In addition, alcohol impairs absorption of thiamin from the digestive tract and hastens its excretion in the urine, tripling the risk of deficiency. The syndrome is characterized by symptoms almost indistinguishable from alcohol abuse itself: apathy, irritability, mental confusion, disorientation, memory loss, jerky eye movements, and a staggering gait (listed in Snapshot 7-6).Footnote Unlike alcohol toxicity, the syndrome responds quickly to an injection of thiamin. Beriberi with possible edema or muscle wasting; enlarged heart, heart failure, muscular weakness, pain, apathy, poor short-term memory, confusion, irritability, difficulty walking, paralysis, jerky eye movements, anorexia, weight loss Riboflavin: deficiency symptoms, such as cracks at the corners of the mouth, sore throat, or hypersensitivity to light, may go undetected because those of thiamin deficiency are more severe. Worldwide, riboflavin deficiency has been documented among children whose eating patterns lack milk products and meats, and researchers suspect that it occurs among some U.S. elderly as well. Cracks and redness at corners of mouth; painful, smooth, purplish red tongue; sore throat; inflamed eyes and eyelids, sensitivity to light; skin rashes Niacin: The niacin-deficiency disease pellagra appeared in Europe in the 1700s when corn from the New World became a staple food. During the early 1900s in the United States, pellagra was devastating lives throughout the South and Midwest. Hundreds of thousands of pellagra victims were thought to be suffering from a contagious disease until this dietary deficiency was identified. The disease still occurs among poorly nourished people living in urban slums and particularly among those with alcohol addiction.Footnote Pellagra is also still common in parts of Africa and Asia.Footnote Its symptoms are known as the four "Ds": diarrhea, dermatitis, dementia, and, ultimately, death. Pellagra, characterized by flaky skin rash (dermatitis) where exposed to sunlight; mental depression, apathy, fatigue, loss of memory, headache; diarrhea, abdominal pain, vomiting; swollen, smooth, bright red or black tongue Folate: Immature red and white blood cells and the cells of the digestive tract divide most rapidly and therefore are most vulnerable to folate deficiency. Deficiencies of folate cause anemia, diminished immunity, and abnormal digestive function. The anemia of folate deficiency is related to the anemia of vitamin malabsorption because the two vitamins work as teammates in producing red blood cells. Research links a chronic deficiency of folate with greater risks for developing breast cancer (particularly among women who drink alcohol), prostate cancer, and other cancers; research also suggests that high doses of folic acid from supplements may speed up cancer progression. Of all the vitamins, folate is most likely to interact with medications. Many drugs, including antacids and aspirin and its relatives, have been shown to interfere with the body's use of folate. Occasional use of these drugs to relieve headache or upset stomach presents no concern, but frequent users may need to pay attention to their folate intakes. These include people with chronic pain or ulcers who rely heavily on aspirin or antacids, as well as those who smoke or take oral contraceptives or anticonvulsant medications. By consuming enough folate both before and during pregnancy, a woman can reduce her child's risk of having one of the devastating birth defects known as neural tube defects (NTD). NTD range from slight problems in the spine to mental retardation, severely diminished brain size, and death shortly after birth. NTD arise in the first days or weeks of pregnancy, long before most women suspect that they are pregnant. Adequate maternal folate may protect against certain other birth defects as well Anemia, smooth, red tongue; depression, mental confusion, weakness, fatigue, irritability, headache; a low intake increases the risk of neural tube birth defects B12: Pernicious anemia;Footnote anemia (large-cell type);Footnote smooth tongue; tingling or numbness; fatigue, memory loss, disorientation, degeneration of nerves progressing to paralysis B6: Because of these diverse functions, vitamin deficiency is expressed in general symptoms, such as weakness, psychological depression, confusion, irritability, and insomnia. Other symptoms include anemia, the greasy dermatitis depicted in Figure 7-18, and, in advanced cases of deficiency, convulsions. A shortage of vitamin may also weaken the immune response. Some evidence links low vitamin intakes with increased risks of some cancers and cardiovascular disease; more research is needed to clarify these associations. Anemia, depression, confusion, abnormal brain wave pattern, convulsions; greasy, scaly dermatitis